The Measure of a Man.

Moving beyond simple fitness tracking, wearable devices may soon offer opportunities for monitoring health and bring vast amounts of new data to the study of human diseases.

[Discussion on Technical Evaluation of Tongue Diagnosis Equipment of Traditional Chinese Medicine].

This study briefly introduces the tongue diagnostic equipment of traditional Chinese medicine. It analyzes and discusses the key points of technical evaluation of tongue diagnostic equipment from the aspects of product name, performance parameters, image processing functions, product use methods, clinical evaluation, etc. It analyzes the safety risks and effectiveness indicators of tongue diagnostic equipment, hoping to bring some help to the gradual standardization of tongue diagnostic equipment and the registration of enterprises.

Home sleep apnea testing: an accuracy study.

AIM: There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed have compared the device used at home with the standard polygraph used in the laboratory. The purpose of this study was therefore to verify the accuracy of the home diagnosis of obstructive sleep apnea syndrome (OSAS) via unassisted type 2 portable polysomnography, compared with polysomnography using the same equipment in a sleep laboratory. METHODS: To avoid any possible order effect on the apnea-hypopnea index (AHI), we randomly created two groups of 20-total 40 patients, according to the test sequence. One of the groups had the first test at home and the second test in the laboratory (H-L); the other group had the first test in the laboratory and the second at home (L-H). The second test always took place on the night immediately following the first test. All polysomnographic monitoring was undertaken with the same equipment, an Embletta X100 system (Embla, Natus Inc., Middleton, USA). The Embletta X100 is a portable polygraph that records eleven polygraph signs: (1) electroencephalogram C4/A; (2) electroencephalogram O2/M1; (3) submental EMG; (4) electrooculogram of the right side; (5) nasal cannula (air flow); (6) respiratory effort against a plethysmographic chest strap; (7) respiratory effort against an abdominal plethysmographic belt; (8) heart rate; (9) saturation of oxyhemoglobin; (10) snoring; and (11) body position. RESULTS: There was no difference in sleep efficiency between the group monitored in the laboratory and the group tested at home (p = 0.30). There was no difference in total sleep time (p = 0.11) or sleep latency (p = 0.52), or in the latency in phases N2 and N3 between the monitoring in the laboratory and at home (N2 p = 0.24; N3 p = 0.09). Some differences occurred regarding the PSG that took place at home, with longer duration of wake after sleep onset (WASO) and longer latency for REM sleep, due to failure of the patient to start the monitoring by pressing the "events" button on the device. In the distribution of sleep phases, there was no difference between the group monitored in the laboratory and the group tested at home. CONCLUSION: Results from home sleep monitoring correlate well with the laboratory "gold standard" and may be an option for diagnosing OSAS in selected patients.

Novel Diagnosis Technologies for a Lack of Oil Lubrication in Gearmotor Systems, Based on Motor Current Signature Analysis.

Due to the wide use of gearmotor systems in industry, many diagnostic techniques have been developed/employed to prevent their failures. An insufficient lubrication of gearboxes of these machines could shorten their life and lead to catastrophic failures and losses, making it important to ensure a required lubrication level. For the first time in worldwide terms, this paper proposed to diagnose a lack of gearbox oil lubrication using motor current signature analysis (MCSA). This study proposed, investigated, and experimentally validated two new technologies to diagnose a lack of lubrication of gear motor systems based on MCSA. Two new diagnostic features were extracted from the current signals of a three-phase induction motor. The effectiveness of the proposed technologies was evaluated for different gear lubrication levels and was compared for three phases of motor current signals and for a case of averaging the proposed diagnostic features over three phases. The results confirmed a high effectiveness of the proposed technologies for diagnosing a lack of oil lubrication in gearmotor systems. Other contributions were as follows: (i) it was shown for the first time in worldwide terms, that the motor current nonlinearity level increases with the reduction of the sgearbox oil level; (ii) novel experimental validations of the proposed two diagnostic technologies via comprehensive experimental trials (iii) novel experimental comparisons of the diagnosis effectiveness of the proposed two diagnostic technologies.

Requirements for Supporting Diagnostic Equipment of Respiration Process in Humans.

There is abundant worldwide research conducted on the subject of the methods of human respiration process examination. However, many of these studies describe methods and present the results while often lacking insight into the hardware and software aspects of the devices used during the research. This paper's goal is to present new equipment for assessing the parameters of human respiration, which can be easily adopted for daily diagnosis. This work deals with the issue of developing the correct method of obtaining measurement data. The requirements of the acquisition parameters are clearly pointed out and examples of the medical applications of the described device are shown. Statistical analysis of acquired signals proving its usability is also presented. In the examples of selected diseases of the Upper Respiratory Tract (URT), the advantages of the developed apparatus for supporting the diagnosis of URT patency have been proven.

Analgesia nociception index as a tool to predict hypotension after spinal anaesthesia for elective caesarean section.

Arterial hypotension is the main disadvantage of spinal anaesthesia (SA) for caesarean delivery with deleterious effects on maternal-foetal outcomes. Recently, a non-invasive device 'analgesia nociception index' (ANI) has been developed to evaluate the parasympathetic component of the nervous autonomous system. The aim of this study was to evaluate the ability of ANI to predict the risk of hypotension after SA for elective caesarean section. One hundred patients scheduled for elective caesarean delivery under SA were recruited in this observational prospective study. Hemodynamic and ANI parameters were recorded in supine position (TB), in sitting position (T0), after induction of SA (T1) and then every three minutes (T2, T3, Tn) until the end of surgery or having resort to ephedrine. After SA, women were classified into two groups according to occurrence of hypotension (group H, n = 80) or not (group C, n = 20). The variations of ANI between T2 and T0 were significantly higher in the group H as compared to the control group. A threshold of 4.5 points decrease in instantaneous ANI value could predict maternal hypotension. ANI is a simple and effective tool in predicting the risk of SA-related hypotension.Impact statementWhat is already known on this subject? Arterial hypotension is the main disadvantage of spinal anaesthesia for caesarean delivery with deleterious effects on maternal-foetal outcomes. The balance between the sympathic and parasympathic systems could be used to predict the onset of hypotension following spinal anaesthesia. Analgesia nociception index (ANI) is an index calculated based on heart rate variability HRV analysis, designed originally to evaluate the antinociception/Nociception balance.What do the results of this study add? We have shown that the analysis of HRV with ANI was a predictor of maternal hypotension after spinal anaesthesia.What are the implications of these findings for clinical practice and/or further research? ANI is an effective tool in predicting the risk of spinal anaesthesia-related hypotension. These findings are of potential clinical importance in the obstetrical anaesthesia setting. Further studies are required in order to implement this simple tool and optimise prophylactic measures especially vasopressors.

Multicentre comparison of quantitative PCR-based assays to detect SARS-CoV-2, Germany, March 2020.

Containment strategies and clinical management of coronavirus disease (COVID-19) patients during the current pandemic depend on reliable diagnostic PCR assays for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we compare 11 different RT-PCR test systems used in seven diagnostic laboratories in Germany in March 2020. While most assays performed well, we identified detection problems in a commonly used assay that may have resulted in false-negative test results during the first weeks of the pandemic.

Measurement of Lumbar Lordosis: A Comparison of 2 Alternatives to the Cobb Angle.

OBJECTIVE: The purpose of this study was to compare 2 alternative methods, the radiologic Harrison Posterior Tangent Method (HPTM) and the nonradiologic Spinal Mouse (SM), to the Cobb angle for measuring lumbar lordosis. METHODS: Sixteen participants with previously existing lateral lumbopelvic radiographs underwent nonradiographic lordosis assessment with a Spinal Mouse. Then 2 investigators analyzed each radiograph twice using the Harrison Posterior Tangent Method and Cobb angle. Correlations were analyzed between HPTM, the Cobb angle, and SM using the Spearman rank correlation coefficient; intraexaminer and interexaminer agreement were analyzed for HPTM and the Cobb angle using intraclass correlation coefficients. RESULTS: The HPTM correlated highly with the Cobb angle (Spearman ρ = 0.936, P < .001); SM had moderate to strong correlations with the Cobb angle (ρ = 0.737, P = .002) and HPTM (ρ = 0.707, P = .003). Intraexaminer and interexaminer agreement for the Cobb angle and HPTM were excellent (all intraclass correlation coefficients > 0.90). One participant had slight kyphosis according to HPTM and SM analyses (which consider the entire lumbar region), whereas the Cobb angle, based only on L1 and L5, reported mild lordosis for that participant. CONCLUSION: In this sample, HPTM measurements showed high correlation with the commonly used Cobb angle, but this method requires more time and effort, and normal values have not been established. The SM may be an alternative when radiographs are inappropriate, but it measures soft tissue contours rather than lordosis itself.

Sudden deafness and tuning fork tests: towards optimal utilisation.

The tuning fork tests have been under attack since their first use in clinical examination. However, the tuning fork is small and fits into every white coat, and tuning fork tests for hearing are easy, accurate and inexpensive. They should be used in patients with an acute unilateral hearing loss if an electric audiometer is not available. After more than 100 years, the tuning fork is not obsolete; tuning fork tests are very useful if used correctly and for the appropriate indication.

Artefactual inflation of type 2 diabetes prevalence in WHO STEP surveys.

OBJECTIVES: In view of erroneous type 2 diabetes prevalence reported in 3 small Pacific Island countries, a study was conducted to investigate whether this error occurred in other countries which have conducted WHO STEPS surveys associated with glucose thresholds for point-of-care (POC) measuring devices calibrated to plasma. METHODS: Published STEPS surveys conducted over 2001-2017 were obtained. For each survey, information was obtained on diabetes prevalence, POC glucose measuring device, blood sample tested and the fasting glucose threshold used for prevalence calculations. POC device user manuals were obtained to determine calibration. The current WHO glucose threshold for type 2 diabetes was used: ≥7.0 mmol/l for plasma glucose; ≥6.1 mmol/l for whole blood glucose. RESULTS: POC devices were used in 75 of the STEPS surveys identified to measure blood glucose. An incorrect glucose threshold was employed in 17 surveys (23%) to define diabetes. The correct threshold was applied in 20 surveys (27%). Estimates from meta-analysis and meta-regression show that diabetes prevalence in surveys using the incorrect glucose thresholds have prevalences 50% higher than surveys which use the correct glucose threshold. A definite conclusion could not be made for 38 surveys (51%) because of the absence or unclear information on the glucose metre and/or the threshold employed. CONCLUSION: WHO STEPS surveys with likely incorrect published diabetes prevalences have been conducted across the globe, resulting in a 50% artefactual inflation. Inaccurate reporting of diabetes prevalence from widely cited STEPS surveys would have significant impacts on disease burden monitoring, policy development and resource allocation.

OBJECTIFS: Compte tenu de la prévalence erronée du diabète de type 2 rapportée dans 3 petits pays insulaires du Pacifique, une étude a été menée pour déterminer si cette erreur s'était produite dans d'autres pays ayant mené des surveillances STEPS de l'OMS, associées à des seuils de glucose pour des appareils de mesure aux points de soins, calibrés sur du plasma. MÉTHODES: Les surveillances STEPS publiées, menées entre 2001 et 2017 ont été obtenues. Pour chaque surveillance, les informations ont été obtenues sur la prévalence du diabète, l'appareil de mesure du glucose aux points des soins, les échantillons de sang testés et le seuil de glycémie à jeun utilisé pour les calculs de prévalence. Les manuels d'utilisation des appareils ont été obtenus pour déterminer l'étalonnage. Le seuil de glucose actuel de l'OMS pour le diabète de type 2 a été utilisé: ≥ 7,0 mmol/L pour le glucose plasmatique; ≥ 6,1 mmol/L pour le glucose du sang total. RÉSULTATS: Les dispositifs de mesure aux points des soins ont été utilisés dans 75 des surveillances STEPS identifiées pour mesurer la glycémie. Un seuil de glucose incorrect a été utilisé dans 17 surveillances (23%) pour définir le diabète. Le seuil correct a été appliqué dans 20 surveillances (27%). Les estimations issues de méta-analyses et de méta-régressions montrent que la prévalence du diabète dans les surveillances utilisant des seuils de glucose incorrects est supérieure de 50% à celle des surveillances utilisant le seuil de glucose correct. Une conclusion définitive n'a pu être tirée pour 38 surveillances (51%) à cause de l'absence ou du manque de clarté des informations sur le glucomètre et/ou le seuil utilisé. CONCLUSION: Les enquêtes STEPS de l'OMS avec des prévalences de diabète publiées probablement incorrectes ont été menées dans le monde entier, entraînant une inflation artéfactuelle de 50%. Des reports inexacts de la prévalence du diabète provenant de surveillances STEPS largement citées auraient des impacts significatifs sur la surveillance de la charge de morbidité, l'élaboration de politiques et l'allocation des ressources.

Cuff Leak Test for the Diagnosis of Post-Extubation Stridor: A Multicenter Evaluation Study.

BACKGROUND:: Cuff leak test was developed to predict the occurrence of post-extubation stridor (PES). This study evaluated the diagnostic performance of this test in unselected critically ill patients. METHODS:: Multicenter prospective study including unselected ventilated patients at the time of their first planned extubation. The diagnostic performance of 4 different cuff leak tests was assessed. RESULTS:: Post-extubation stridor occurred in 34 (9.4%) of 362 included patients. Compared to patients without PES, patients with PES required more frequently reintubation (6 [17.6%] vs 26 [7.9%], P = .041), prolonged duration of ventilation (6 [3-13] vs 5 [2-9] days, P = .029), and longer intensive care unit (ICU) stay (12 [6-17.5] vs 7.5 [4-13] days, P = .018). However, ICU mortality was similar in both groups (1 [2.9%] vs 23 [7.0%], P = .61). The 4 cuff leak tests display poor diagnostic accuracy: sensitivities ranging from 27% to 46%, specificities from 70% to 88%, positive predictive values from 14% to 19%, and negative predictive values from 92% to 93%. CONCLUSION:: Post-extubation stridor occurs in less than 10% of unselected critically ill patients. The several cuff leak tests display limited diagnostic performance for the detection of PES. Given the high rate of false positives, routine cuff leak test may expose to undue prolonged mechanical ventilation.

Ernst Trömner: beyond the reflex hammer.

Ernst Trömner (1868-1930) was a German neurologist and psychiatrist at the St. Georg Hospital in Hamburg. As clinician and researcher, he contributed to our understanding of various fields within neurology including language and speech disorders, hypnosis and suggestion, sleep physiology and diseases, leukemia with nervous system involvement, gait disorders, metabolic myelopathy, Parkinson's disease, organic psychosis, and schizophrenia. However, his main interest was muscle reflexes. De facto, Trömner described a variant of the Achilles tendon reflex, a modification of the Oppenheim's and Babinski's reflexes, "rediscovered" the corneomandibular reflex and described the joint reflexes of the lower extremities as well as a muscle stretch reflex of the diaphragm. Moreover, Trömner has developed the first sedimentation chamber to assess the cerebrospinal fluid as well as the muscle plessimeter and, probably most considerable, the reflex hammer which is widely used by neurologists around the globe to date and is commonly referred to as the "Trömner hammer." His name has also become inextricably linked with the finger flexor reflex, which is commonly known as the "Trömner reflex." This article briefly summarizes Professor Ernst Trömner's life and his contributions to clinical neurology and psychiatry beyond his most famous eponyms, the hammer and the finger flexor reflex.

Accessibility of Medical Diagnostic Equipment for Patients With Disability: Observations From Physicians.

OBJECTIVE: To explore attitudes and practices of physicians relating to accessible medical diagnostic equipment in serving patients with mobility disability. DESIGN: Open-ended individual telephone interviews, which reached data saturation. Interview recordings were transcribed verbatim for qualitative conventional content analysis. SETTING: Massachusetts, the United States, October 2017-January 2018. PARTICIPANTS: Practicing physicians from 5 clinical specialties (N=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Common themes concerning physical accessibility. RESULTS: Mean ± SD time in practice was 27.5±12.5 years; 14 practices had height-adjustable examination tables; and 7 had wheelchair-accessible weight scales. The analysis identified 6 broad themes: height-adjustable examination tables have advantages; height-adjustable examination tables have drawbacks; transferring patients onto examination tables is challenging; rationale for examining patients in their wheelchairs; perceptions of wheelchair-accessible weight scales; and barriers and facilitators to improving physical accessibility. Major barriers identified by participants included costs of equipment, limited space, and inadequate payment for extra time required to care for persons with disability. Even physicians with accessible examination tables sometimes examined patients seated in their wheelchairs. CONCLUSIONS: Even if physicians have accessible equipment, they do not always use it in examining patients with disability. Future efforts will need to consider ways to eliminate these access barriers in clinical practice. Given small sample size, results are not generalizable to physicians nationwide and globally.

Short communication: Diagnosis and classification of clinical and subclinical mastitis utilizing a dynamometer and a handheld infrared thermometer.

In times of ongoing automatization of dairy cow husbandry, objective and reliable tools for mastitis diagnostic are highly in demand. The objective of this study was to investigate the diagnostic value of a handheld dynamometer and an infrared thermometer to diagnose and score clinical and subclinical mastitis and to compare those values with results from palpation of the udder tissue. Overall, 218 cows with clinical mastitis (i.e., 46 mild, 106 moderate, and 66 severe cases), 142 with subclinical mastitis, and 68 healthy cows were enrolled. Our data provide evidence that the dynamometer is an accurate diagnostic tool to differentiate between healthy udder quarters, and those with subclinical and clinical mastitis. Furthermore, the severity score of clinical mastitis can be estimated by dynamometer. The firmness threshold for the detection of clinical mastitis was 1.002 kg. Using a threshold of 1.175 kg in clinical mastitis quarters, it was possible to differentiate between negative and positive bacteriological results. A differentiation between healthy and clinical mastitis quarters with the infrared thermometer was possible, albeit udder surface temperatures were highly influenced by ambient temperature. Udder surface temperature increased by 0.15 to 0.18°C for each degree of ambient temperature. In conclusion, the utility of an infrared thermometer to estimate the udder health status of dairy cows is limited, whereas the handheld dynamometer appeared to be an accurate and objective method.

Analysis of the Health Product Profile Directory - a new tool to inform priority-setting in global public health.

BACKGROUND: The Health Product Profile Directory (HPPD) is an online database describing 8-10 key characteristics (such as target population, measures of efficacy and dosage) of product profiles for medicines, vaccines, diagnostics and other products that are intended to be accessed by populations in low- and middle-income countries. The HPPD was developed by TDR on behalf of WHO and launched on 15 May 2019. METHODS: The contents of the HPPD were downloaded into an Excel™ spreadsheet via the open access interface and analysed to identify the number of health product profiles by type, disease, year of publication, status, author organization and safety information. RESULTS: The HPPD contains summaries of 215 health product profiles published between 2008 and May 2019, 117 (54%) of which provide a hyperlink to the detailed publication from which the summary was extracted, and the remaining 98 provide an email contact for further information. A total of 55 target disease or health conditions are covered, with 210 profiles describing a product with an infectious disease as the target. Only 5 product profiles in the HPPD describe a product for a non-communicable disease. Four diseases account for 40% of product profiles in the HPPD; these are tuberculosis (33 profiles, 15%), malaria (31 profiles, 14%), HIV (13 profiles, 6%) and Chagas (10 profiles, 5%). CONCLUSION: The HPPD provides a new tool to inform priority-setting in global health - it includes all product profiles authored by WHO (n = 51). There is a need to standardise nomenclature to more clearly distinguish between strategic publications (describing research and development (R&D) priorities or preferred characteristics) compared to target product profiles to guide a specific candidate product undergoing R&D. It is recommended that all profiles published in the HPPD define more clearly what affordability means in the context where the product is intended to be used and all profiles should include a statement of safety. Combining the analysis from HPPD to a mapping of funds available for R&D and those products in the R&D pipeline would create a better overview of global health priorities and how they are supported. Such analysis and increased transparency should take us a step closer to measuring and improving coordination of efforts in global health R&D.

SLAM Project - Second-Level Diagnostic Assessment: Multidisciplinary approach to HIV Patients.

The aim of the study is to propose a multidimensional second-level diagnostic assessment to allow follow- up in the event physicians observe the presence of risk factors and/or active co-morbidities in HIV-infected patients. To develop our proposal, we chose the Delphi method that has been used for about 30 years in the healthcare field. The CISAI Group (Coordinamento Italiano per lo Studio dell'Allergia in Infezione da HIV) conducted this study. The first phase of the study provided identification of the questionnaire for second-level diagnostic assessment of HIV-infected patients. From March to July 2018 the questionnaire was submitted to 48 experts from 10 Italian HIV-dedicated sites. The questionnaire consisted of 102 items divided into 7 survey areas. The results can be summarized as follows: infectious disease diagnostics, 18 items reached agreement in 9 cases; osteoporosis diagnostics 12 items with 3 agreements; metabolic and cardiovascular diagnostics 13 items with 4 agreements; nephrology diagnostics 19 items with 8 agreements; hepatology diagnostics 12 items with 9 agreements; CNS diagnostics: 18 items with 7 agreements; psychological diagnostics and quality of life assessment (QoL) 10 items with no agreement. If these considerations are confirmed in required discussions and in-depth analyses, they will be able to produce an important indication in the drafting of national guidelines.

Prospective study of the sensitivity of the Wood's lamp for common eye abnormalities.

OBJECTIVE: The Wood's lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood's lamp for common eye abnormalities. STUDY DESIGN: We examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice. This prospective observational trial was performed from December 2016 until July 2017. An ophthalmologist examined the patient's eyes with a Wood's lamp, followed by examination of the eyes using a slit lamp. The Wood's lamp was compared with the slit lamp, which served as the gold standard. RESULTS: There were 73 patients recruited. The mean age of study subjects (29 female and 44 male) was 49 years. The overall sensitivity of the Wood's lamp was 52% (38/73; 95% CI 40% to 64%). Based on the principal final diagnosis made with the slit lamp, the Wood's lamp only detected 9 of 16 corneal abrasions, 5 of 10 corneal ulcers, 5 of 9 corneal foreign bodies, 0 of 4 cases of non-herpetic keratitis, 1 of 2 cases of herpes keratitis, 1 of 5 rust rings and 18 of 28 other diagnoses. CONCLUSIONS AND RELEVANCE: Examination using the Wood's lamp fails to detect many common eye abnormalities. Our findings support the need for a slit lamp examination of patients with eye complaints whenever possible.

Metasurfaces for Advanced Sensing and Diagnostics.

Interest in sensors and their applications is rapidly evolving, mainly driven by the huge demand of technologies whose ultimate purpose is to improve and enhance health and safety. Different electromagnetic technologies have been recently used and achieved good performances. Despite the plethora of literature, limitations are still present: limited response control, narrow bandwidth, and large dimensions. MetaSurfaces, artificial 2D materials with peculiar electromagnetic properties, can help to overcome such issues. In this paper, a generic tool to model, design, and manufacture MetaSurface sensors is developed. First, their properties are evaluated in terms of impedance and constitutive parameters. Then, they are linked to the structure physical dimensions. Finally, the proposed method is applied to realize devices for advanced sensing and medical diagnostic applications: glucose measurements, cancer stage detection, water content recognition, and blood oxygen level analysis. The proposed method paves a new way to realize sensors and control their properties at will. Most importantly, it has great potential to be used for many other practical applications, beyond sensing and diagnostics.

A Diagnostic Device for In-Situ Detection of Swine Viral Diseases: The SWINOSTICS Project.

In this paper, we present the concept of a novel diagnostic device for on-site analyses, based on the use of advanced bio-sensing and photonics technologies to tackle emerging and endemic viruses causing swine epidemics and significant economic damage in farms. The device is currently under development in the framework of the EU Commission co-funded project. The overall concept behind the project is to develop a method for an early and fast on field detection of selected swine viruses by non-specialized personnel. The technology is able to detect pathogens in different types of biological samples, such as oral fluids, faeces, blood or nasal swabs. The device will allow for an immediate on-site threat assessment. In this work, we present the overall concept of the device, its architecture with the technical requirements, and all the used innovative technologies that contribute to the advancements of the current state of the art.